双腔支气管插管单肺通气对气道高反应患者气道压及肺内分流的影响

Effects of double-lumen endotracheal intubation and one-lung ventilation on airway pressure and intrapulmonary shunt in patients with higher airway reaction

目的观察双腔支气管插管单肺通气对气道高反应患者气道压及肺内分流的影响。方法选择胸科手术患者38例,ASA Ⅰ～Ⅱ级。其中左肺癌行左肺叶或左全肺切除术18例(L组,n=18),食管中、下段癌行根治术20例(E组,n=20),麻醉诱导后双腔支气管插管,微量泵持续泵注丙泊酚4 mg·kg^(-1)·h^(-1),间断静脉滴注维库溴铵、芬太尼维持麻醉。单肺通气参数设定为:潮气量8 ml/kg,呼吸频率15次/min,吸:呼=1:2,吸入氧浓度100%。侧卧位后记录右肺通气气道压,分别于麻醉前(入室未吸氧),双肺通气15 min,单肺通气20 min,单肺通气60 min桡动脉、中心静脉抽血测血气分析,计算肺内分流率。结果与双腔通气时比较,单肺通气时动脉血氧分压(PaO_2)均明显下降,气道压明显升高,2组肺内分流明显增高。与E组患者比,L组患者在单肺通气20 min时气道压明显增高(P<0.05)、在单肺通气20 min、60 min时肺内分流率明显增高(P<0.05)。结论双腔支气管插管单肺通气使气道高反应患者气道压增高,肺内分流增加。

Objective To investigate the effect of double-lumen endotracheal intubation and one-lung ventilation on airway pressure and intrapulmonary shunt in patients with higher airway reaction. Methods Thirty-eight ASA Ⅰ～Ⅱ patients （ 28 males and 10 females ）, aged 40 - 75yr undergoing elective thoracic surgery were divided into two groups ： lung group （ group L, n = 18 ）, esophagus group （ group E, n = 20）, and a left-side double-lumen tube was inserted, then the patients were mechanically ventilated. The ventilation conditions were FiO2 = 100%, VT = 8ml/kg, I： E = 1 ： 5, f = 15bpm, during OLV. Anesthesia was maintained with continuous infusion of propofol supplemented with intermittent i. v. boluses of fentanyl and vecuronium. The MAP, HR, ECG, CVP, airway pressure were continuously monitered during anesthesia. The arterial and pulmonary blood gases were analyzed before induction of anesthesia （ TI ）, 15min after two-lung ventilation （ T2 ）, 20min （ T3 ） and 60rain （ T4 ） after OLV. The Qs/Qt（ shunt fraction）was calculated. Results Qs/Qt was significantly increase after induction of general anesthesia and mechanical ventilation ,which increased further during OLV, as compared with the baseline value（T1 ） in two groups. The calculated Qs/Qt values were the highest at 20min（33 ）of OLV and remained at higher values for 30min, then gradually decreased. The Paw and Qs/Qt were significantly higher in group L than those in group E at 20min after OLV. Conclusion The double-lumen endotracheal intubation and one-lung ventilation can increase the airway pressure and intrapuhnonary shunt in patients with higher airway reaction.